Basic Information
| Provider Information | |||||||||
| NPI: | 1871634766 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAPLE STAR NEVADA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 N CRAYCROFT RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857111448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207476694 | ||||||||
| FaxNumber: | 5207476613 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 IDAHO ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898013713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757382484 | ||||||||
| FaxNumber: | 7757385756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOERNING | ||||||||
| AuthorizedOfficialFirstName: | BREEANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5207476694 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.